Safety-net hospitals at higher risk for readmissions--but not necessarily because of socioeconomic factors

The Centers for Medicare & Medicaid Services devotes more and more resources to identifying social determinants of health, but the agency may discount the significance of care quality after discharge, according to new research published in Health Affairs.

Researchers, led by Steven Sheingold, director of the Department of Health and Human Services' Division of Health Financing Policy, analyzed Medicare hospital claims data from fiscal 2009 to fiscal 2012, determining their fiscal 2013 penalties based on 2012 readmission rates. They augmented the numbers with additional Medicare administrative data on patient characteristics at the time of admission.

When they compared the results for safety-net providers--which treat a disproportionate number of patients with low socioeconomic status--and other providers, they found little difference in penalties between the two classifications. While the risk of a penalty was higher for safety-net institutions, most of them received a 1 percent penalty, the lowest possible, in fiscal 2013 and 2014.

The researchers also found that readmission odds remained up to 7 percent higher for safety-net providers even after controlling for factors such as income and race, failing to account for about 40 percent of the disparities.

"Together, these findings suggest the need for a careful evaluation of policy alternatives that factor socioeconomic status into penalty calculations for excess readmissions to determine whether such alternatives could have a significant impact on penalties while remaining consistent with overall objectives for delivery system transformation," they wrote.

The quality of patients' post-discharge care, or whether they receive any at all, is a likely overlooked determinant of readmissions, the authors write, such as patient destination upon leaving the hospital, which is itself likely a combination of factors such as patient/provider preferences and patient access to such services.

The findings will likely intensify the controversy over CMS' measures for readmission penalties, which groups such as the American Hospital Association argue fail to account for sociodemogaphic factors, FierceHealthcare previously reported.